tbuckley/cabot-search huggingface dataset:
Abstract 136: The Effect Of Mechanical Chest Compression Device On Survival After Out-of-hospital Cardiac Arrest According To Patient Transport Interval: A Multicenter Observational Study
Authors: Jooyeong Kim, Sungwoo Moon, Jong-Hak Park, Sejoong Ahn, Hanjin Cho, Juhyun Song, Kim S Jin
Journal: Circulation (2022)

Objectives: This study aimed to investigate the effect of mechanical chest compression device (MCPRD) on patients with OHCA according to patient transport interval (PTI). We hypothesized that MCPRD is effective on survival with prolonged PTI compared with manual chest compression (non-MCPRD). Methods: This cross-sectional multicenter observational study used the Korean Cardiac Arrest Research Consortium registry data from 2015 to 2019. Emergency medical service (EMS) treated OHCAs presumed of cardiac etiology without return of spontaneous circulation (ROSC) at scene were included. Exposure was prehospital MCPRD use and PTI. The main outcome was survival to admission. PTI was categorized into three groups; short PTI for 0-5 minutes, intermediate for 6-10 minutes and long PTI for over 10 minutes, respectively. Multivariable logistic regression was performed to estimate the adjusted odds ratios (AORs) and its’ corresponding 95% confidence intervals (95% CI) for the effect of MCPRD compared with manual compression on outcome. Interaction of PTI on the effect of MCPRD on outcome were tested. To control for selection bias and confounding factors, propensity score (PS) matched cohort was extracted. PS score for each patient to receive MCPRD was estimated using a multivariable logistic regression model. To reduce the standard error of MCPRD on outcomes, a two-to-one propensity score matched cohort was extracted. Results: For unmatched cohort, a total of 3,530 patients were eligible and after PS matching, a total of 2,049 patients were eligible for the analysis. The MCPRD was applied at 19.3% of all unmatched cohort. After adjusting for potential confounders, the AOR of MCPRD for survival to admission was 1.36 (95% CI 1.07-1.72) for unmatched cohort and 1.37 (95% CI 1.06-1.78) for PS matched cohort. Interaction according to PTI on the effect of MCPRD was significant at prolonged PTI on both cohorts; AOR 1.60 (95% CI 1.06-2.42) for unmatched cohort and AOR 1.60 (95% CI 1.06-2.42) for PS matched cohort, respectively. Conclusion : For patients with OHCA with PTI longer than 10 minutes, MCPRD use showed a significant survival benefit compared with manual chest compressions. Further studies are needed to evaluate the appropriate use of MCPRD in special situations.
Abstract 13523: The Role of Mitochondrial-Associated-Membranes in Ca-Dependent Arrhythmias
Authors: Arpita Deb, OLUWABORI ADEKANYE, Bjorn C Knollmann, Bin Liu
Journal: Circulation (2022)

Introduction: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a stress-induced arrhythmic syndrome due to genetic defects of the sarcoplasmic reticulum (SR) Ca release channel complex of ryanodine receptor 2 (RyR2). Recent studies suggest that mitochondria function as a protective Ca buffer to absorb RyR2-mediated aberrant Ca release in CPVT. However, the molecular mechanism underlying the protective Ca buffering function of CPVT mitochondria remains unclear. Hypothesis: We hypothesize that the tethering between SR and mitochondria, also known as mitochondria-associated-membranes (MAMs) are promoted in CPVT to facilitate SR-mitochondria Ca transfer. Moreover, manipulating SR-mitochondria tethering or MAMs impacts arrhythmogenesis in CPVT. Methods: Ventricular myocytes were isolated from a CPVT model of CASQ2 knockout (Cnull) mouse. Cellular immunofluorescence assays and western blots were employed to detect MAMs remodeling in CPVT cells. Pharmacological approach was employed to disrupt MAMs and examine its effect on cellular arrhythmogenesis using live-cell imaging. Results: SR-mitochondria tethering was assessed by examining the interaction between RyR2 and Voltage-dependent anion channel (VDAC), a protein localized in the mitochondrial-outer-membrane. As compared with wild-type (WT), we detected a higher degree of colocalization of immunofluorescence between RyR2 and VDAC in Cnull cells, as well as increased RyR2-VDAC interactions by proximity ligation assay. The expression of SR-mitochondria tethering protein Mitofusin2 was increased in MAMs isolated from CPVT hearts. Colchicine was employed to induce a partial disruption of MAMs in Cnull cells. In intact Cnull cells perfused with β agonist isoproterenol, colchicine exacerbated arrhythmogenic Ca waves. In permeabilized cells, colchicine increased the frequency of arrhythmogenic Ca waves and reduced mitochondrial Ca uptake. Conclusions: Our results support that MAMs are promoted in CPVT cells to facilitate SR-mitochondria Ca transfer so mitochondria can function as a protective Ca buffer. Pharmacological disruption of SR-mitochondria tethering limits SR-mitochondria Ca transfer, thus exacerbating cellular arrhythmic burden.
Abstract 13038: Association of Hemolysis Biomarkers and Acute Kidney Injury in Cardiogenic Shock Patients Supported With Impella Ventricular Assist Device
Authors: Daniel Lim, Brianna Balansay, Jainy Savla, Siwen Ding, Nisha Bansal, Nayan Arora, Claudius Mahr, Song Li
Journal: Circulation (2022)

Introduction: Hemolysis is a frequent complication in cardiogenic shock patients supported with Impella and can lead to acute kidney injury (AKI). We assessed the association between three hemolysis biomarkers, lactate dehydrogenase (LDH), plasma-free hemoglobin (pfHb), and haptoglobin, and AKI to determine the optimal biomarker in predicting AKI. Methods: Cardiogenic shock patients on Impella support (CP or 5.0) for more than 24 hours from 6/1/2016 to 9/1/2020 at the University of Washington Medical Center were retrospectively enrolled. By institutional protocol, the three biomarkers were measured daily while patients were on Impella support. The association between each biomarker and the development of stage 2 or worse AKI (creatinine increase of ≥ 100% or requiring hemodialysis) within 24 hours of biomarker collection was assessed using logistic regression. Plots of AKI probability over the range of values of each biomarker were constructed using natural splines. Results: Out of 251 included patients (mean age 56.2 ± 15.8 years, 78% male, 69% white), 128 (51%) developed stage 2 or worse AKI. LDH and pfHb values had statistically significant associations with the development of stage 2 or worse AKI within 24 hours of each measurement (OR 1.016 [95% CI 1.009-1.022] per 100 IU/L of LDH, OR 1.092 [95% CI 1.067-1.117] per 10 mg/dL of pfHb, p-value &lt; 0.001 for both) while haptoglobin values did not (p-value 0.6). The association with AKI was stronger for pfHb compared to LDH (McFadden’s R 2 0.12 for pfHb vs 0.03 for LDH). The association of each biomarker and AKI is illustrated in Figure 1. Conclusions: In cardiogenic shock patients supported with Impella, higher LDH and pfHb values were associated with AKI while haptoglobin values were not, and pfHb had a stronger association with AKI than LDH. Our results support the use of pfHb to detect hemolysis and risk of impending AKI in patients supported with Impella. Figure 1. Probability of stage 2 or worse AKI based on biomarker values.
Abstract 12805: Incidence and Predictors of Myocardial Infarction or Stent Thrombosis in High-Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention
Authors: Johny Nicolas, Alessandro Spirito, Samantha Sartori, Zhongjie Zhang, Nicholas Pitaro, Davide Cao, Birgit Vogel, Frans Beerkens, David Youssef, Davis Jones, Madison Edens, Daniel Feldman, Anton Camaj, David Power, Joseph Sweeny, Samin K Sharma, Annapoorna Kini, George Dangas, Roxana Mehran
Journal: Circulation (2022)

Introduction: High-bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) are often at high risk for thrombotic complications following coronary stenting. We sought to evaluate the frequency and predictors of myocardial infarction (MI) or stent thrombosis (ST) events in HBR patients at 1 year after PCI. Methods: We included HBR patients undergoing PCI with drug-eluting stent implantation at a tertiary-care center, between 2012 and 2019. HBR status was defined as the presence of ≥1 major or ≥2 minor Academic Research Consortium-HBR criteria. Clinical and angiographic baseline characteristics were analyzed after stratifying patients by the occurrence of MI/ST. Independent predictors of MI/ST at 1-year follow-up were assessed using Cox multivariate regression analysis. Results: Among 7,806 HBR patients undergoing PCI, 245 (3.1%) experienced MI/ST within one year of the index procedure. These patients were more frequently female (42.6% vs. 35.7%, p=0.03), had a higher prevalence of insulin-dependent diabetes mellitus (62.3% vs. 40.5%, p&lt;0.001), peripheral artery disease (18.4% vs. 13.4%, p=0.03), chronic kidney disease (57.1% vs. 52.1%, p=0.006), and a history of prior PCI (57.1% vs. 45.7%, p&lt;0.001). Furthermore, they were more likely to undergo complex PCI (43.3% vs. 32.3%, p&lt;0.001) and had a higher mean syntax score (20.6±12.5 vs. 14.2±10.8, p&lt;0.001). Multivessel disease was the most prevalent and strongest predictor of MI/ST at 1-year follow-up, followed by acute coronary syndrome and diabetes mellitus ( Figure ). Conclusions: MI/ST events frequently occur in HBR patients undergoing PCI. Predictors of MI/ST must be accounted for while deciding on the optimal antithrombotic therapy strategy in these patients.
Abstract 13836: Factors Associated With a Complicated Hospital Course in Patients With Spontaneous Coronary Artery Dissection: A Report of the iSCAD Registry
Authors: Fahad Alkhalfan, Malissa Wood, sahar naderi, Katherine Leon, C M Gibson, Gerald C Chi, Anna Grodzinsky, Heather L Gornik, Bryan J Wells, Jennifer Lewey, Angela Taylor, Daniella Kadian Dodov, Connie N Hess, Stanislav Henkin, Kathryn Lindley, Gretchen Morris, James L Orford, Lori Tam, Dharam J Kumbhani, Samuel Norris, Cassandra Reyes, Clara Vitarello, Esther S Kim
Journal: Circulation (2022)

Introduction: Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome in younger patients. Though associated with lower short and long-term mortality, there is still a need to identify the subset of patients who are at a higher risk of adverse events or a more complex hospital course. Methods: Using data from the iSCAD Registry, a multicenter registry of patients with SCAD, univariate and multivariable logistic regression models were created to assess the association between factors related to the index admission and a complicated hospital course. A complicated hospital course was defined as the occurrence of either a recurrent myocardial infarction (MI), cerebrovascular accident (CVA), a new arrhythmia, heart failure requiring diuretics, ≥ 2 angiograms performed, or a hospital admission of more than 5 days. The multivariable logistic regression model was developed using a backward selection approach with exit criteria set at p &gt;0.2. Patients presenting with cardiac arrest were excluded. Results: Of the 414 patients included, 159 patients (38.4%) had a complicated hospital course: 76 patients had a prolonged admission, 27 had a recurrent MI, 1 had a CVA, 39 had an arrhythmia, 13 had heart failure requiring diuretics and 72 had ≥ 2 angiograms in the index admission. The final model showed that patients who had structural complications related to MI, fibromuscular dysplasia (FMD), or a history of cardiomyopathy were more likely to experience a complicated hospital course (Table). Finally, patients on anticoagulation were at a higher risk of having the composite outcome but this may be secondary to the indication for anticoagulation. Conclusions: The presence of structural complications related to MI, a diagnosis of FMD, or a history of cardiomyopathy were associated with an increased risk of a complicated hospital course related to SCAD. Identification of risk factors for a complex inpatient stay may help to tailor the acute care of SCAD patients.
Abstract 13472: Physical Incapacity in Heart Failure Patients is Associated With Skeletal Muscle Mitochondrial Dysfunction
Authors: Andreas B Tinggaard, Maria Kreiberg K Skou, Lotte Sørensen, Jacob Seefeldt, Niels Jessen, Helene Norrelund, Henrik Wiggers
Journal: Circulation (2022)

Introduction: The role of skeletal muscle mitochondrial dysfunction in exercise intolerance in heart failure patients is unknown. Therefore, this study aimed to identify the relationship between physical capacity and skeletal muscle mitochondrial function in patients with heart failure and reduced ejection fraction (HFrEF). Methods A total of 53 HFrEF patients and 20 age- and sex-matched controls underwent dual-energy X-ray absorptiometry to assess muscle mass by the appendicular lean mass index (ALMI), cardiopulmonary exercise testing (peakVO2), 6-minute walking test (6MWD) and maximal isometric knee-extensor strength test. In skeletal muscle biopsies from vastus lateralis, mitochondrial respiratory capacity was measured by high resolution respirometry. We performed Pearson correlations to examine the relationships between physical capacity tests and mitochondrial function. Results Mean age of the study cohort was 71.7 ±7.0 years. Compared with healthy controls, HFrEF patients had a lower peakVO2 (14.6 ±4.1 vs. 26.2 ±8.0 mL/kg/min, p &lt;0.001) and a shorter 6MWD (429 ±106 vs. 581 ±93 m, p &lt;0.001). HFrEF patients had a lower ALMI (0.74 ±0.15 vs. 0.86 ±0.16 kg/(kg/m 2 ), p = 0.005). Maximal coupled mitochondrial respiration was decreased in HFrEF patients compared with healthy controls (59.1 ±19.0 vs. 92.6 ±38.8 ρmol O 2 *s -1 mg -1 , p &lt;0.001) as well as the respiratory control ratio (7.2 ±2.5 vs. 9.7 ±3.1). Maximal coupled mitochondrial respiration was correlated to peakVO2 (r = 0.58, p &lt;0.001) and 6MWD (r = 0.44, p &lt;0.001), but not to muscle mass or maximal knee-extensor strength. Conclusions HFrEF patients had a lower peakVO2, shorter 6MWD and impaired skeletal muscle mitochondrial function as compared with controls. Maximal coupled mitochondrial respiration was correlated with physical capacity across the population of HFrEF patients and healthy controls establishing an association between skeletal muscle mitochondrial dysfunction and physical incapacity.
Abstract 12889: Sex Differences in Exercise Capacity After Home-Based Cardiac Rehabilitation During the Covid-19 Pandemic
Authors: Tomoaki Hama, Audry Chacin Suarez, Thomas G Bissen, Thomas P Olson
Journal: Circulation (2022)

Introduction: Many center-based cardiac rehabilitation programs were forced to close during the pandemic resulting in a programmatic shift to delivering cardiac rehabilitation remotely in the home-based setting. This study examined sex differences in the change of exercise frequency and exercise capacity in patients participating in home-based cardiac rehabilitation (HBCR) during the COVID-19 pandemic. Methods: Retrospective cohort study of 567 HBCR patients between March 2020 and May 2021. Patients who completed the Duke Activity Status Index questionnaire before and after HBCR were included. We calculated the number of reported exercise days/ week, exercise min/day, and VO 2 peak estimated. Patients were divided into two groups according to sex (Male/Female). Continuous data are described as mean±SD and baseline data compared with a two-sample t-test. The delta change from pre-post between groups also are compared with a two-sample t-test. Results: Of 567 HBCR patients, 118 patients completed both pre and post HBCR questionnaires (Male, n=82, 66±12 yo vs Female, n=36, 65±12 yo, p=0.80). There were no differences between groups for baseline exercise days/week or exercise min/day pre HBCR (4.0±2.8 vs 4.1±3.0 days, p=0.87; 22±20 vs 18±20 min, p=0.33); however, VO 2 peak at baseline HBCR was higher in males than females (22.3±8.1 vs 18.9±5.9 ml/kg/min, p&lt;0.05). Both groups improved exercise days/week (4.0±2.8 to 5.7±1.5 vs 4.1±3.0 to 5.7±1.4 days, p&lt;0.05 for both), exercise min/day (22±20 to 40±15 vs 18±20 to 37±21 min, p&lt;0.05 for both), and VO 2 peak (22.3±8.1 to 27.8±8.0 vs 18.9±5.9 to 22.7±6.5, ml/kg/min, p&lt;0.05 for both). In addition, there was no significant difference for the delta change of the three outcomes between groups (1.7±2.7 vs 1.6±2.5 days; 18±19 vs 19±18 min; 5.5±6.5 vs 3.8±4.5 ml/min/kg, p&gt;0.05 for all). Conclusions: Female patients entering HBCR during the COVID-19 pandemic demonstrated lower exercise capacity compared to males; however, both female and male patients increased exercise frequency (days/week and min/day) and exercise capacity (estimated VO 2 peak) similarly after attending HBCR during the COVID-19 pandemic.
Abstract 12969: Impact of Race and Ethnicity on Hospital Morbidity and Resource Utilization in Acute Care Pediatric Cardiology Patients
Authors: Brittney K Hills, Dana B Gal, Sarah T Plummer, MAYTE FIGUEROA, Anita Krishnan, Andrea M Sawyer-Gray, Johnisha Grabinski, Colleen Pater, Sonali S Patel, Amy J Schiller, Nicolas Madsen
Journal: Circulation (2022)

Introduction: Disparities in healthcare outcomes are well described among patients of different races and ethnicities including pediatric cardiology. Multicenter studies examining these outcomes are lacking in pediatric acute care cardiology. We hypothesize that Black and Hispanic patients admitted to pediatric acute care cardiology units have increased hospital and acute care encounter length of stay (LOS) and complication rates compared to their White and non-Hispanic peers. Methods: Utilizing the Pediatric Acute Care Cardiology Collaborative registry, we examined all acute care cardiology unit encounters from 2/1/2019 to 7/30/2021 ending in discharge to home or death. Hospitalizations were categorized by race and ethnicity. In-hospital complications included health-care acquired infections, iatrogenic incidents, pneumonia, sepsis, seizures and stroke. Data were analyzed for differences in LOS and complication rates using chi-square and ANOVA testing. We used Bonferroni correction to establish a significance threshold of 0.007. Results: Analysis included 30,404 hospitalizations from 29 centers. There were 16,233 White (70%), 4,533 Black (19%), 919 Asian (4%) and 1,629 other races (7%) encounters. There were 23,592 (78%) non-Hispanic and 4,583 (15%) Hispanic encounters. Black patients had higher rates of premature birth (21.4%) and low birth weight (10.7%), compared to White patients (15.6% and 5.9% respectively, p&lt;0.0001). Both non-Hispanic Black and Hispanic patients had longer total hospital and acute care LOS than non-Hispanic White patients. Complication rates analyzed by race trended towards significance between Black and White patients, and Hispanic patients had a higher complication rate than non-Hispanics. ( Table 1 ) Conclusions: Despite improved outcomes for patients with congenital and acquired heart disease, significant racial and ethnic disparities continue to exist. Directed efforts are needed to achieve equitable results.
Abstract 12922: Detection of the Effect of Nicotine Delivered by E-Cigarettes or Standard Cigarettes on Cardiovascular System From a Carotid Waveform Using a Physics-Based Machine Learning Approach
Authors: Rashid Alavi, Wangde Dai, Rebecca J Arechavala, Michael T Kleinman, Robert A Kloner, Niema M Pahlevan
Journal: Circulation (2022)

Introduction: We have recently shown (Alavi et al. Circulation, (2021)144: A13745-A13745) that adverse effects of nicotine delivered chronically by electronic cigarette (EC) vapor or standard cigarettes on left ventricular systolic function can be captured using intrinsic frequency (IF) method applied on carotid waveforms. Here, we propose a hybrid IF-machine learning (ML) method to detect nicotine effect on cardiovascular system using a carotid waveform. Methods: Total number of n=117 young healthy adult male and female Sprague Dawley rats (49% (n=57) female, weight ~200-250 g) were randomized and exposed to: 1) purified air, n=32; 2) EC vapor without nicotine (EC NIC-), n=26; 3) EC vapor plus nicotine (EC NIC+), n=27; and 4) standard cigarette smoke from reference combustion cigarettes (3R4F), n=32. All the exposures (nose-only) took place for duration of 5 hours/day, 4 days/week for total of 8 weeks. Third-generation type EC from VaporFi, tank model: Volt 2 was used. E-liquid was tobacco flavored with a 50/50 propylene glycol/glycerin ratio. Similar nicotine amount as the standard cigarette was delivered to the rats of EC NIC+ group. After 8 weeks of exposure, IFs were computed from invasively measured carotid waveforms. A support vector machine (SVM) classifier with radial basis function kernel was trained using IF data from 83 rats to detect (non)-nicotine groups. The k -fold cross-validation ( k =10) was used to avoid overfitting. The remaining rats were used for generalization test (n=14) and stratified blind test (n=20). Results: Our SVM model showed positive and negative predictive values of 66.7% and 76.9%, respectively. Sensitivity and specificity were 82.4% and 58.8% for test data (Fig1). Conclusions: Our results suggest that nicotine delivered by ECs or cigarettes can be detected by a physics-based ML model from a single carotid waveform. This method can potentially be used for detecting adverse effect of nicotine on cardiovascular system noninvasively.
Abstract 13125: Endotrophin as a Marker of Outcomes in Heart Failure With Preserved Ejection Fraction Patients With and Without Diabetes
Authors: Alexandra L. Moeller, Alexander Reese-Petersen, Patricia Palau, Eloy Dominguez, Morten Karsdal, Federica Genovese, Julio E Nuez Llota
Journal: Circulation (2022)

Introduction: Hyperglycemia-mediated tissue injury can lead to cardiac fibrosis and vascular damage, key drivers of heart failure with preserved ejection fraction (HFpEF). We investigated the potential of endotrophin (ETP), a pro-fibrotic molecule generated during type VI collagen formation, as a risk marker of outcomes in HFpEF patients with and without diabetes from the TRAINING-HF study. Methods: We measured ETP by the PRO-C6 ELISA in serum from 48 patients with symptomatic HFpEF (42% males, mean±SD age of 73±9 years, 45% with diabetes). Outcomes included hospitalization for heart failure (HHF) and all-cause mortality. Cox proportional hazards models adjusted for conventional risk factors (age, sex, BMI, systolic blood pressure, and smoking), and ROC curve- and Kaplan-Meier analyses adjusted for diabetes (multiple logistic regression) were applied. Results: Levels of ETP were significantly elevated in patients experiencing HHF (p=0.009), all-cause mortality (p=0.034), and underlying diabetes (p=0.018). Higher levels of ETP were independently associated with HHF (hazard ratio (HR): 2.29, p=0.002) and all-cause mortality (HR: 2.1, p=0.002) when adjusted for conventional risk factors. There was no interaction between ETP and the presence of diabetes (p=0.97; p=0.08, respectively). In crude analyses, levels of ETP were significantly associated with the risk of HHF and all-cause mortality (AUC=0.75, p=0.004; AUC=0.79, p=0.004, respectively) and a significantly increased risk of HHF (p=0.01) and all-cause mortality (p=0.006) was seen with increasing tertiles of ETP. When adjusting for diabetes, the prognostic potential of ETP for HHF and all-cause mortality remained significant (AUC=0.76, p=0.007; AUC=0.77, p=0.008, respectively), and there was a significant association between increasing tertiles of ETP and HHF (p=0.018), but not for all-cause mortality (p=0.112). Conclusions: Levels of ETP were significantly elevated in HFpEF patients with diabetes. Interestingly, ETP was independently associated with the risk of HHF and all-cause mortality when adjusting for diabetes. Further studies are needed to investigate how diabetes impacts the prognostic potential of ETP in HFpEF patients.